Cholera

11 Key excerpts on "Cholera"

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  Cholera

  • Sivakumar Joghi Thatha Gowder(Author)
  • 2012(Publication Date)
  • IntechOpen

    (Publisher)

  Part 1 Epidemiology 1 Cholera and Spatial Epidemiology Frank B Osei 1 , Alfred A Duker 2 and Alfred Stein 3 1 Faculty of Public Health and Allied Sciences, Catholic University College of Ghana, Sunyani 2 Department of Geomatic Engineering, Kwame Nkrumah University of Science and Technology, Kumasi, 3 Faculty of Geo-Information Science and Earth Observation (ITC), Twente University, 1, 2 Ghana 3 Netherlands 1. Introduction Cholera is an acute intestinal infection caused by the water borne bacteria Vibrio Cholerae O1 or O139 ( V. Cholerae ). Infection is mainly through ingestion of contaminated water or food (Kelly, 2001). Approximately 10 2 -10 3 cells are required to cause severe diarrhea and dehydration (Sack et al., 1998; Hornich et al., 1971). Ingested Cholera vibrios from contaminated water or food must pass through the acid stomach before they are able to colonize the upper part of the small intestine. After penetrating the mucus layer, V. Cholerae colonizes the epithelial lining of the gut, secreting Cholera toxin which affects the small intestine. Clinically, the majority of Cholera episodes are characterized by a sudden onset of massive diarrhea and vomiting. This is accompanied by the loss of profuse amounts of protein-free fluid along with electrolytes, bicarbonates and ions. The resulting dehydration produces tachycardia, hypotension, and vascular collapse, which can lead to sudden death. The diagnosis of Cholera is commonly established by isolating the causative organism from the stools of infected individuals. The main mode of treatment is the replacement of electrolyte loss through the intake of a rehydration fluid, i.e. Oral Rehydration Salts (ORS) (Sack et al., 2004). Without prompt treatment, fatality rate can be as high as 50% (WHO, 1993; Sack et al., 2004).

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  Agents of Bioterrorism

  Pathogens and Their Weaponization

  • Geoffrey Zubay(Author)
  • 2008(Publication Date)
  • Columbia University Press

    (Publisher)

  CHAPTER 12

  Cholera (VIBRIO CholeraE)

  Rohit Puskoor

  V

  ibrio Cholerae is the causative agent of the gastrointestinal disease Cholera, noted for its characteristic dehydration and massive diarrhea. The disease devastated the world’s populations in the nineteenth and early twentieth centuries, causing major pandemics. Although vaccines and therapeutic measures have since been developed, the disease is still a public health problem in parts of Africa, Asia, and Latin America, where health care is poor and extreme poverty precludes adequate medical care and preventive measures. An epidemic in central Africa in 1994 and 1995 presented case fatality rates as high as 30% in areas where medical facilities were limited.

  Clinical symptoms appear soon after V. Cholerae secretes the Cholera toxin, an A-B-type toxin. The B subunit binds to galactose residues on the cell surface.14 The A subunit triggers the irreversible activation of the cell’s G proteins that causes efflux of ions and water into the intestinal lumen, leading to the watery diarrhea characteristic of Cholera. Because of Cholera’s severe incapacitating symptoms, its high rate of fatality when untreated, and the possibility of genetically engineering a more potent strain, V. Cholerae represents a significant threat as a biological weapon.

  HISTORY

  Cholera was first observed on the Indian subcontinent, with mentions in Sanskrit writings of a dehydrating diarrhea disease.3 Epidemic Cholera was first recorded in 1563. In 1854, John Snow hypothesized that water was the primary pathway of transmission for Cholera following London’s Broad Street outbreak, which led to 56 deaths within 2 days. In 1883, Robert Koch isolated V. Cholerae from the feces of Cholera patients and identified it as the infective agent. In an 1884 paper, Koch described the bacteria as “comma-shaped.”12

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  Significance, Prevention and Control of Food Related Diseases

  • Hussaini Anthony Makun(Author)
  • 2016(Publication Date)
  • IntechOpen

    (Publisher)

  Introduction Cholera is an acute diarrheal illness, caused by the toxigenic strains of the bacterium Vibrio Cholerae serogroups O1 or O139 [1, 2]. It is one of the important public health problems in Asia and Africa and causes substantial morbidity and mortality [3]. Since centuries, Cholera has been a subject of interest for epidemiologists. The studies regarding Cholera helped in the development of new epidemiological methods which led to the understanding of not only Cholera transmission but also helped in the development of the science of infectious disease epidemiology [4]. The purpose of this chapter is to discuss this important infectious disease, i.e., its historical aspects, clinical features, epidemiology, and the outbreaks caused by Cholera. © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Moreover, the preventive measures for Cholera and methods of control of Cholera outbreaks will also be discussed. 1.1. Historical aspects of Cholera For centuries, Cholera remained one of the most horrific diseases [5]. It was first described by Hippocrates in the fifth century BC. Traditionally, the Ganges Delta region in Asia is consid‐ ered the home of Cholera. It is believed that Cholera spread throughout the world from this region. Several epidemics occurred in Asia during the fifteenth and eighteenth centuries. Seven major pandemics of Cholera have occurred since 1817 [3, 6]. Historians believe that the impact of Cholera epidemics on the cultural evolution of Western Europe, was far reaching and it altered the social matrix of European culture. During the nineteenth century Cholera was not only considered a terrifying disease, but was also a challenge to national identity and national economy [7].

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  International Handbook of Foodborne Pathogens

  • Marianne D. Miliotis, Jeffrey W. Bier(Authors)
  • 2003(Publication Date)
  • CRC Press

    (Publisher)

  14

  Vibrio Cholerae

  G. H. Rabbani, David A. Sack, and M. R. Choudhury

  International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

  I. BACKGROUND

  Cholera is a disease of great antiquity. The term “Cholera,” first mentioned by Hippocrates, signifies the Greek words, chole (bile) and rein (flow), thus meaning flow of bile (1–3). Some authorities claim that the word came from cholades, meaning the intestine, or the Greek word Cholera, which means gutter or roof (4 ). In the Vedic Sushruta Samhita, which originated about 500 B.C., the disease Cholera was believed to be denoted by the Sanskrit word visuchika (5 ). The writings of modern historians indicate that, for more than 2000 years, Cholera must have been a very familiar disease worldwide, because a name for it exists in most cultures, signifying a broad spectrum of the intestinal diseases (1 ,3 ).

  Since 1817 there have been seven pandemics of Cholera. The first six originated from the delta regions of eastern India, particularly Bengal, and swept all over the world, claiming a heavy toll in human lives. The seventh pandemic started in an Indonesian island in early 1960s and has spread to all continents. Although a contagious cause of Cholera had been suspected by many authorities, including John Snow as early as 1859, it was Robert Koch who studied Cholera in Egypt and India and first isolated the comma-shaped organisms from the victims of Cholera in 1883; the bacterium was called Kommabazillen (2 ,6 ). Since then advances in Cholera research have significantly contributed to the understanding of the organism and the disease caused by it.

  II. CHARACTERISTICS

  The taxonomy of the family Vibrionaceae, which include Vibrio Cholerae, is in transition. The current classification has been reviewed by West and Col well (7 ). The members of the genus Vibrio are halophilic and natural inhabitants of the estuarine and marine environment. The genus Vibrio contains several bacterial species, of which V. Cholerae and V. parahaemolyticus are the two most important pathogens of humans. V. Cholerae is a gram-negative, monoflagellate, short, straight, or curved rod (0.5 × 1.5–3.0 |μm) (Fig. 1 ). V. Cholerae is classified on the basis of its somatic antigens (O-antigens) into 60–70 serovars (serotypes) (8 ). The serovar 0:1 includes all the strains responsible for the epidemic and endemic Cholera and has two subtypes, Ogawa and Inaba; a Hikojima subtype has been reported rarely. All these subtypes can be further distinguished into two biovars (biotypes), Classical and El Tor. El Tor differs from the Classical biovar in several aspects. El Tor is resistant to Mukherjee's group IV phage and to polymixin B, it causes agglutination of chicken erythrocytes (9 ), it produces a hemolysin, and it is Voges-Proskauer positive (10 ). More than 30 species have been recognized as belonging to the genus Vibrio, although many of them differ in DNA characteristics (11 ,12

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  New Generation Vaccines

  • Myrone M. Levine, Myron M. Levine, Gordon Dougan, Michael F. Good, Margaret A. Liu, Gary J. Nabel, James P. Nataro, Rino Rappuoli, Myrone M. Levine, Myron M. Levine, Gordon Dougan, Michael F. Good, Gary J. Nabel, James P. Nataro, Rino Rappuoli, Myrone M. Levine, Myron M. Levine, Gordon Dougan, Michael F. Good, Gary J. Nabel, James P. Nataro, Rino Rappuoli(Authors)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  However, the incidence of O139 disease quickly fell to below 5% of all Cholera cases (2), and infection was only seen in a few countries in Southeast Asia. Cholera Disease The disease caused by toxigenic V. Cholerae O1 and O139 is characterized by watery diarrhea without blood and mucus (2). The acute, profuse watery diarrhea usually lasts for a few days. In a proportion of Cholera cases, however, life-threatening dehydrating disease and acidosis ensue. The case fatality rate in severe, nontreated Cholera is 30% to 50%. Persons of blood group O have an increased risk of developing severe Cholera (Cholera gravis) when infected (10–14). The keystones to treat-ment of Cholera gravis are aggressive rehydration therapy and antibiotics. Virulence Factors and Pathogenesis Cholera is primarily a disease originating from the upper part of the small intestine. Intestinal perfusion studies have revealed that as much as 90% of the intestinal secretion occurs in the uppermost 1 m of the intestine in adult Cholera patients. V. Cholerae O1 (and O139) bacteria have developed special, highly efficient means to colonize and multiply to prodigious numbers in the small intestine, and in this process they also efficiently produce and release Cholera toxin (CT) (2,15). Through its high-affinity binding to the gut epithelium and its subsequent cellular action, CT is directly responsible for the pathogenic effects on intestinal ion and water secretion pro-cesses that may lead to life-threatening diarrhea and dehydra-tion (16,17).

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  Tropical Medicine

  A Clinical Text, 8th Edition, Revised and Expanded

  • Kevin M. Cahill(Author)
  • 2013(Publication Date)
  • Fordham University Press

    (Publisher)

  Diarrheal Diseases Cholera Cholera has existed in the Ganges Delta since time immemorial, but in the nineteenth century, six great pandemics spread as far and rapidly as man was then able to travel. A seventh pandemic due to the El Tor biotype began in Indonesia in 1961, spreading throughout southern Asia and into Africa, killing tens of thousands. In Bangladesh and India, the classical vibrio biotype appears to be regaining its dominant position, and outbreaks continue to occur early each winter and spring, account- ing for 6% of fatal cases of childhood diarrhea in the area. Cholera is also a threat in many humanitarian emergencies; following conflict and natural disasters, people are often forced to live together in refugee enclaves with inadequate clear water supplies and grossly unsanitary conditions. An outbreak in Haiti in 2010 that killed thousands of refu- gees is a reminder of the virulence of this infection. The Organism Vibrio Cholerae is a motile, gram-negative bacillus shaped like a comma, with a single polar flagellum. It is distinguished from other morphologi- cally identical vibrios by agglutination with group OI type serum. There are two biotypes: the classical and El Tor; and three serotypes: Inaba, Ogawa, and Hikojima. These vibrios flourish in the alkaline, bile- enriched environment of the small intestine; a common laboratory medium for Cholera isolation is the alkaline agar (TCBS) medium. In positive cultures, round, yellow, smooth colonies appear after 18 hours. In 1992, a new strain of V. Cholerae, 0139 Bengal, appeared in India and caused an epidemic in a population that was largely immune to Cholera caused by V. Cholerae OI strains. Outbreaks have since occurred in other areas of south Asia. 116 diarrheal diseases Transmission is from human to human via the anal-oral route and most frequently follows the ingestion of water or food contaminated with Cholera stools.

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  Manual of Security Sensitive Microbes and Toxins

  • Dongyou Liu(Author)
  • 2014(Publication Date)
  • CRC Press

    (Publisher)

  Epidemiologically, the disease is characterized by its tendency to appear in explosive outbreaks and its predisposition to causing pandemics that may spread to other countries and continents. Despite concerted control and prevention efforts, the disease continues to cause a major public health problem in developing countries, especially those in Africa, parts of Asia, the Middle East, and South and Central America. Disruptions of public sanitation services by civil unrest, natural disasters (e.g., earthquake, tsunami, volcanic eruptions, landslides, and floods) are important contributing factors for the outbreaks of Cholera disease in endemic areas. Application of rapid diagnostic tests such as nucleic acid-based techniques is critical for prompt identifi-cation and confirmation of Cholera epidemics. Because chol-era is a severe acute dehydrating diarrheal disease, rapid fluid and electrolyte replacement represents an effective first-line treatment, and use of antibiotics such as tetracycline in severe Cholera helps shorten the duration of illness and lessen the amount of fluid replacement. Prevention of Cholera outbreaks relies on personal hygiene, water treatment, and emergency responses as well as vaccination. REFERENCES 1. Daniels NA, Shafaie A. A review of pathogenic Vibrio infec-tions for clinicians, Infect. Med . 17, 665, 2000. 2. Farmer JJ, Janda M. Vibrionaceae. In: Bergey’s Manual of Systematic Bacteriology , 2nd ed., Vol. 2, The Proteobacteria, p. 491, Garrity, G.M. et al. (eds.), Springer-Verlag, New York, 2005. 3. Berche P et al. The novel epidemic strain O139 is closely related to the pandemic strain O1 of Vibrio Cholerae , J. Infect. Dis . 170, 701, 1994. 4. Li BS et al. Phenotypic and genotypic characterization Vibrio Cholerae O139 of clinical and aquatic isolates in China. Curr. Microbiol . 62, 950–955, 2011. 5. Sack DA et al. Cholera. Lancet 363, 223–233, 2004. 6. Cariri FAMO et al.

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  Bacterial Protein Toxins V2A

  • Solomon Kadis(Author)
  • 2012(Publication Date)
  • Academic Press

    (Publisher)

  Without quantitative tools, progress will continue to be slow. During the past decade, however, perhaps stimulated by the resurgence of Cholera in Asia beginning in 1958, there has been a coordinated effort on the part of clinicians, physiologists, pathologists, and microbiologists to gain an un-derstanding of the mechanisms of pathogenicity in Cholera. Out of this effort has come a growing consensus that the pathophysiology of Cholera can probably best be explained on the basis of a toxin elaborated by the vibrio in the intestinal lumen. There has also come hope that if the basic mechanism of fluid production in Cholera can be brought to light, it will contribute to a better understanding of the mechanisms involved in other diarrheal diseases, and, more importantly, of normal intestinal phys-iology as well. I I . P a t h o p h y s i o l o g y a n d M o r b i d A n a t o m y of C h o l e r a It is not the intent of this discourse to present a detailed account of the human host's response to Cholera. Nevertheless, a brief mention of the major historical developments in our understanding of this disease and a synopsis of the present state of our knowledge of the functional and structural derangements which occur in Cholera in man would appear to be prerequisites to a discussion of Cholera toxins. It seems clear that hy-potheses concerning the mechanism of pathogenicity of toxins derived from laboratory experiments must be consonant with the facts learned from the care and study of Cholera patients. 192 J. P. CRAIG Observations of clinical Cholera strongly support the view that all the clinical manifestations of even the most severe Cholera can be attributed entirely to local alterations of fluid and electrolyte movement in the small bowel resulting in fluid and electrolyte loss from the plasma compartment and, consequently, hypovolemic shock. Renal failure and pneumonia are always secondary phenomena, and irreversible shock has not been observed.

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  Vaccines

  New Approaches to Immunological Problems

  • Ronald W. Ellis(Author)
  • 2014(Publication Date)
  • Butterworth-Heinemann

    (Publisher)

  CHAPTER 3 Cholera Vaccines Carol O. Tacket John Clemens James B. Kaper Cholera was one of the large group of infectious diseases, such as anthrax, tuberculosis, typhoid fever, diphtheria, and tetanus, for which etiologic agents were discovered in the late 19th century. In the more than 100 years since that time, the study of Cholera and of its etiologic agent Vibrio Cholerae serotype Ol has progressed with advances in microbiology. More recently, Cholera research has exploited the technology of molecular biology. The possibility of immunoprophylaxis against Cholera was raised almost as soon as the role of V. Cholerae was discovered. The history of modern vaccine development in general is reflected in the history of attempts at vaccine development against Cholera. After 100 years, the reality of a safe, effective, long-lasting, and single-dose Cholera vaccine may now be close at hand. 3.1 IMMUNOLOGY OF Cholera Cholera is a disease with a high potential for successful prevention by vac-cination since primary infection stimulates strong protective immunity against subsequent infection. Infection-derived immunity has been dem-53 54 Cholera Vaccines onstrated both by epidemiologic studies and by volunteer challenge studies. In studies of a population of 240,000 residents of Matlab, Bangladesh, Glass and coworkers showed that second hospitalizations for Cholera were many fewer than predicted by a life-table analysis, suggesting that a primary ep-isode of clinical Cholera provided significant protection against a second episode (Glass et al. 1982). In volunteer studies, an initial infection provides protection against rechallenge with organisms of homologous biotype (Cash et al. 1974a; Levine 1980; Levine et al. 1981). The level of protection de-pends on the biotype of the primary infection.

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  Hunter's Tropical Medicine and Emerging Infectious Diseases E-Book

  • Edward T Ryan, David R Hill, Tom Solomon, Naomi Aronson, Timothy P Endy(Authors)
  • 2019(Publication Date)
  • Elsevier

    (Publisher)

  Diarrhea is defined as the passage of loose or watery stools at least three times in a 24-hour period. Diarrheal illness is classified as acute watery diarrhea, invasive diarrhea, or persistent diarrhea. This classification scheme reflects differences in the etiology, pathogenesis, and management of each type of diarrheal illness.

  Acute Watery Diarrhea

  Infectious agents are the most common cause of acute watery diarrhea. In most cases of acute watery diarrhea, it is not necessary to identify a specific microbiologic diagnosis and antibiotics are not indicated. An exception to this is Vibrio Cholerae infection (Chapter 47 ), which often occurs in epidemics. It is useful to distinguish Cholera from other causes of acute watery diarrhea, as patients with severe Cholera have rapid fluid losses and benefit from antibiotic therapy. The diagnosis of Cholera is suggested by vomiting and by the passage of voluminous watery diarrhea, which may have a characteristic “rice-water stool.” Cholera should be suspected when otherwise healthy children over 5 years or adults die of watery diarrhea. Although numerous other pathogens also cause acute watery diarrhea, the most common etiologies are rotavirus in infants and enterotoxigenic Escherichia coli (ETEC) in older children and adults. There is increasing recognition of the role of norovirus and other viruses as a major cause of epidemic, and sporadic, acute watery diarrhea in adults and children.

  Although acute watery diarrhea is most often caused by infection of the gastrointestinal tract, other systemic illnesses common in developing countries are also associated with acute watery diarrhea. Systemic viral infections associated with diarrhea include influenza, measles, dengue fever, and Ebola. Bacterial infections associated with diarrhea include urinary tract infection, sepsis, pneumonia, and meningitis. Patients with malaria can present with diarrhea. Surgical emergencies, such as intussusception or appendicitis, may also present with diarrhea. For these reasons, the presence of acute watery diarrhea is not sufficient clinical evidence to exclude other potentially life-threatening infections, and a history and complete physical examination should be performed on all patients presenting with diarrhea.

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  Vaccines E-Book

  Vaccines E-Book

  • Walter A. Orenstein, Paul A. Offit, Kathryn M. Edwards, Stanley A. Plotkin, Walter Orenstein(Authors)
  • 2017(Publication Date)
  • Elsevier

    (Publisher)

  18

  Diarrhea Caused by Bacteria

  Jan Holmgren, Anna Lundgren

  Diarrheal infections are estimated to cause 1.7 billion disease episodes and 700,000 deaths each year, mainly in children in low- and middle-income countries.1 Travelers to endemic areas are also at high risk for being infected. However, today there are only licensed vaccines against two bacterial enteric pathogens, Salmonella enterica serovar Typhi (S . Typhi) and Vibrio Cholerae. There are intense efforts under way to develop vaccines against additional important agents, in particular enterotoxigenic Escherichia coli (ETEC) and Shigella . This chapter focuses on vaccine development efforts for these two groups of pathogens and also briefly discusses the development of vaccines against Campylobacter , Shiga toxin–producing E. coli (STEC), and nontyphoidal Salmonella (NTS). While ETEC and Shigella have exclusively human reservoirs, Campylobacter , STEC, and NTS are also zoonotic pathogens with known animal reservoirs (chicken, cattle, etc). Our discussion here is limited to vaccines for human use, but it should be noted that there are also ongoing efforts to develop veterinary vaccines aimed at indirectly reducing the spread to human populations.

  Pathogenesis and Protective Immune Mechanisms

  Enteric pathogens differ in the way they cause infection and disease and this influences what type of immune responses they elicit and how vaccination may protect against infection and disease.2 The different bacterial enteropathogens can cause disease by: (a) colonizing the intestinal mucosa without invasion or morphological damage but eliciting diarrhea by means of powerful secreted enterotoxins (e.g., V. Cholerae and ETEC); (b) adhering to the mucosa and inducing enterocyte effacement by “injecting” bacterial proteins into the epithelial cells (e.g., enteropathogenic E. coli ); (c) inducing enterocyte killing by producing powerful exotoxins that block cellular protein synthesis (e.g., enterohemorrhagic E. coli [EHEC/STEC]); (d) locally invading and destroying the mucosa (e.g., Shigella ); (e) locally invading the mucosa and inducing inflammation (e.g., NTS); and (f) translocating across the mucosa, invading the bloodstream and spreading to distal organs (e.g., S. Typhi and S.

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